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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

40001264

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Power Sex

Date of Birth December 4, 1923 Place of Birth HalifaxCounty of Halifax

Name of Father   MAIDEN NAME of Mother  

Residence of Father when child was born Present address of Father 12 Bedford Row, Halifax

Occupation of Father at Birth of child Canadian National Express Assistant Foreman Place of birth of Father Boston

Race Name and present address of Physician in attendance at birth

Signature of Applicant Address of Applicant 12 Bedford Row, Halifax Date March 20, 1928

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Power

Born at Halifax in the County of Halifax

That Power Whose Birth is sought to be registered was

born at Halifax Halifax County on December 4, 1923

My knowledge of the fact and date of such Birth is based on the following Circumstances:

I am her father

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